Wound complications following kidney and liver transplantation
Wound complications following kidney and liver transplantation
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DOI：
10.1111/j.1399-0012.2006.00608.x
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发表时间：
2006-01-01
影响因子：
2.1
通讯作者：
Schmidt, J.
中科院分区：
文献类型：
--
作者：
Mehrabi, A.;Fonouni, H.;Schmidt, J.
手术技术和免疫抑制（IS）的进步已导致移植后并发症的明显减少。然而，伤口并发症可能是最常见的移植后手术并发症类型，仍然会限制这些改善的结局，并导致住院时间延长、再次住院和再次手术，从而增加整体移植成本。我们的目的是回顾文献，以描述肾脏和肝脏移植（KTx，LTx）后伤口并发症的循证危险因素，并提出这种令人烦恼的发病率的预防和治疗方式。通常，伤口并发症被分类为浅表和深部伤口裂开、移植物周围积液和血清肿、浅表和深部伤口感染、蜂窝织炎、淋巴囊肿和伤口引流。几项研究的结果表明，伤口并发症最重要的风险因素是IS和肥胖。此外，还有手术和/或技术因素，包括切口类型、再次手术和外科医生的专业知识，以及合并症，如高龄、糖尿病、营养不良和尿毒症。伤口并发症的预防性管理需要确定其病因，以便解决和减少其对愈合过程的有害影响。应根据患者的共存风险因素调整IS模式和药物，特别是西罗莫司（SRL）和类固醇（ST）。SRL应在移植后3个月给予，ST应尽快逐渐减少。体重指数（BMI）低于30 kg/m2是移植计划的建议，但较高的BMI并不排除受体。手术风险因素可以通过应用精确的手术技术来预防。治疗方式必须侧重于最有效和最具成本效益的药物和/或干预措施，以促进和改善伤口愈合。
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m(2) is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.